PMID- 31094331
OWN - NLM
STAT- MEDLINE
DCOM- 20200214
LR  - 20230502
IS  - 1438-8871 (Electronic)
IS  - 1439-4456 (Print)
IS  - 1438-8871 (Linking)
VI  - 21
IP  - 5
DP  - 2019 May 13
TI  - Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial 
      of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating 
      University Students.
PG  - e11349
LID - 10.2196/11349 [doi]
LID - e11349
AB  - BACKGROUND: Prevention of depression is a priority to reduce its global disease 
      burden. Targeting specific risk factors, such as rumination, may improve 
      prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed 
      to specifically target depressive rumination. OBJECTIVE: The primary objective of 
      this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the 
      incidence of major depression relative to usual care in UK university students. 
      The secondary objective was to test the feasibility and estimated effect sizes of 
      unguided i-RFCBT. METHODS: To address the primary objective, a phase III 
      randomized controlled trial was designed and powered to compare high risk 
      university students (N=235), selected with elevated worry/rumination, recruited 
      via an open access website in response to circulars within universities and 
      internet advertisements, randomized to receive either guided i-RFCBT (interactive 
      Web-based RFCBT, supported by asynchronous written Web-based support from 
      qualified therapists) or usual care control. To address the secondary objective, 
      participants were also randomized to an adjunct arm of unguided 
      (self-administered) i-RFCBT. The primary outcome was the onset of a major 
      depressive episode over 15 months, assessed with structured diagnostic interviews 
      at 3 (postintervention), 6, and 15 months post randomization, conducted by 
      telephone, blind to the condition. Secondary outcomes of symptoms of depression 
      and anxiety and levels of worry and rumination were self-assessed through 
      questionnaires at baseline and the same follow-up intervals. RESULTS: 
      Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), 
      or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% 
      relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). 
      Participants with higher levels of baseline stress benefited most from the 
      intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in 
      rumination, worry, and depressive symptoms were found in the short-to-medium 
      term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 
      2.25), with 46% (38/82) being compliant (completing >/=4 modules). Similar effect 
      sizes and compliance rates were found for unguided i-RFCBT. CONCLUSIONS: Guided 
      i-RFCBT can reduce the onset of depression in high-risk young people reporting 
      high levels of worry/rumination and stress. The feasibility study argues for 
      formally testing unguided i-RFCBT for prevention: if the observed effect sizes 
      are robustly replicated in a phase III trial, it has potential as a scalable 
      prevention intervention. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12683436; 
      https://www.isrctn.com/ISRCTN12683436 (Archived by WebCite at 
      http://www.webcitation.org/77fqycyBX). INTERNATIONAL REGISTERED REPORT IDENTIFIER 
      (IRRID): RR2-10.1186/s13063-015-1128-9.
CI  - (c)Lorna Cook, Mohammod Mostazir, Edward Watkins. Originally published in the 
      Journal of Medical Internet Research (http://www.jmir.org), 13.05.2019.
FAU - Cook, Lorna
AU  - Cook L
AUID- ORCID: 0000-0002-1958-8583
AD  - SMART Lab, Mood Disorders Centre, School of Psychology, University of Exeter, 
      Exeter, United Kingdom.
FAU - Mostazir, Mohammod
AU  - Mostazir M
AUID- ORCID: 0000-0002-8657-515X
AD  - College of Life and Environmental Sciences (CLES), School of Psychology, 
      University of Exeter, Exeter, United Kingdom.
FAU - Watkins, Edward
AU  - Watkins E
AUID- ORCID: 0000-0002-2432-5577
AD  - SMART Lab, Mood Disorders Centre, School of Psychology, University of Exeter, 
      Exeter, United Kingdom.
LA  - eng
GR  - WT_/Wellcome Trust/United Kingdom
PT  - Clinical Trial, Phase III
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20190513
PL  - Canada
TA  - J Med Internet Res
JT  - Journal of medical Internet research
JID - 100959882
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cognitive Behavioral Therapy/*methods
MH  - Depression/*prevention & control/*therapy
MH  - Female
MH  - Humans
MH  - Internet
MH  - Male
MH  - Rumination, Cognitive/*physiology
MH  - Students
MH  - Universities
MH  - Young Adult
PMC - PMC6536298
OTO - NOTNLM
OT  - cognitive behavioral therapy
OT  - depression
OT  - prevention
OT  - rumination, cognitive
OT  - stress, psychological
OT  - student health services
COIS- Conflicts of Interest: EW developed the original RFCBT intervention. The other 
      authors declare they have no competing interests.
EDAT- 2019/05/17 06:00
MHDA- 2020/02/15 06:00
PMCR- 2019/05/13
CRDT- 2019/05/17 06:00
PHST- 2018/06/22 00:00 [received]
PHST- 2019/03/24 00:00 [accepted]
PHST- 2019/03/15 00:00 [revised]
PHST- 2019/05/17 06:00 [entrez]
PHST- 2019/05/17 06:00 [pubmed]
PHST- 2020/02/15 06:00 [medline]
PHST- 2019/05/13 00:00 [pmc-release]
AID - v21i5e11349 [pii]
AID - 10.2196/11349 [doi]
PST - epublish
SO  - J Med Internet Res. 2019 May 13;21(5):e11349. doi: 10.2196/11349.